APP FRM --------------------------------------------------------------------------------| || || LOCAL PC ORGANIZATION || MEMBERSHIP APPLICATION || || (check one) || || || NEW MEMBER PROSPECTIVE NEW MEMBER || ---- ---- *CHECK || *HERE || NAME: || ---------------------------------------------- ---- || STREET ADDRESS: || ---------------------------------------------- ---- || CITY-STATE-ZIP: || ------------------------ ------ ------------ ---- || PHONE (Home): || ---------------------------------------------- ---- || PHONE (Business): || ---------------------------------------------- ---- || || * This column is to be checked if this line of information is not to be || released in the club membership roster. || || PAYMENT OF DUES: cash or check number || -------- -------- || DUES: $30.00 per year starting in January or prorated at the rate of $2.50 || per month. || ||------------------------------------------------------------------------------|| || || LOCAL PC ORGANIZATION || MEMBERSHIP APPLICATION || || (check one) || || || NEW MEMBER PROSPECTIVE NEW MEMBER || ---- ---- *CHECK || *HERE || NAME: || ---------------------------------------------- ---- || STREET ADDRESS: || ---------------------------------------------- ---- || CITY-STATE-ZIP: || ------------------------- ----- ------------ ---- || PHONE (Home): || ---------------------------------------------- ---- || PHONE (Business): || ---------------------------------------------- ---- || || || * This column is to be checked if this line of information is not to be || released in the club membership roster. || || PAYMENT OF DUES: cash or check number || -------- -------- || || DUES: $30.00 per year starting in January or prorated at the rate of $2.50 || per month. || |--------------------------------------------------------------------------------
